<!--
  ========================LICENSE_START=================================
  screenit-web
  %%
  Copyright (C) 2012 - 2020 Facilitaire Samenwerking Bevolkingsonderzoek
  %%
  This program is free software: you can redistribute it and/or modify
  it under the terms of the GNU Affero General Public License as published by
  the Free Software Foundation, either version 3 of the License, or
  (at your option) any later version.
  
  This program is distributed in the hope that it will be useful,
  but WITHOUT ANY WARRANTY; without even the implied warranty of
  MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.  See the
  GNU General Public License for more details.
  
  You should have received a copy of the GNU Affero General Public License
  along with this program.  If not, see <http://www.gnu.org/licenses/>.
  =========================LICENSE_END==================================
  -->
<html xmlns:wicket="http://wicket.apache.org">
<wicket:panel>
    <div class="modal-header">
        <button data-dismiss="modal" class="close" type="button">x</button>
        <h3>Huisarts selecteren</h3>
    </div>
    <div class="modal-body">
        <div id="zoeken" style="display: block;">
            <form wicket:id="zoekForm" class="not-tracked-for-changes-on-page">
                <div class="form-container huisarts-zoek-form">
                	<div class=row-fluid>
	            		<div class="span6">
                    		<div class="control-group">
                        		<label class="control-label" style="width: 340px;">Naam huisarts/huisartsenpraktijk</label>
                        		<div class="controls">
                            		<input type="text" style="width: 340px;" wicket:id="achternaam"/>
                        		</div>
                    		</div>
                    	</div>
                    	<div class="span6">
	                    	<div class="control-group">
	                        	<label class="control-label">Straatnaam</label>
	                        	<div class="controls">
	                            	<input type="text" style="width: 340px;" wicket:id="adres.straat"/>
	                        	</div>
	                    	</div>
						</div>
					</div>
                	<div class=row-fluid>
	            		<div class="span2" style="width: 65px;">
                    		<div class="control-group">
                        		<label class="control-label">Postcode</label>
                       			<div class="controls">
                           			<input type="text" style="width: 55px;" wicket:id="adres.postcode"/>
                       			</div>
                   			</div>
                    	</div>
	            		<div class="span8">
		                    <div class="control-group">
        		                <label class="control-label">Plaats</label>
                		        <div class="controls">
                        	    	<input type="text" style="width: 258px;" wicket:id="adres.plaats"/>
                        		</div>
                    		</div>
                    	</div>             
                   		<div class="span2">
                       		<div class="buttons" style="margin-top: 20px; margin-left: 42px;">
                           		<button type="button" class="btn btn-primary" wicket:id="zoeken"><i class="icon-search icon-white"></i>Zoeken</button>
                       		</div>
                    	</div>
                	</div>
                </div>
            </form>

            <div class="huisarts-geen-zoekresultaten" style="display: none;">
                Zoek met behulp van bovenstaand formulier naar de huisarts van de cli&euml;nt.
            </div>

            <div class="huisarts-zoekresultaten"
                 wicket:id="zoekResultatenContainer">
                <h2 wicket:id="aantalResultaten"></h2>
                <div wicket:id="zoekResultaten">
                    <ul class="zoekresultaten">
                        <li>
                            <div class="naam">Vries, H. de</div>
                            <address>
                                Plaats 9a <br> 8224AB Lelystad
                            </address>
                            <div class="praktijknaam">Huisartspraktijk de Kameleon</div>
                            <div class="selectie">
                                <button class="btn btn-primary">Selecteren</button>
                            </div>
                        </li>
                    </ul>
                </div>
            </div>
        </div>
    </div>

    <div class="modal-footer">
        <button id="huisartsOnbekendBtn" class="btn pull-left" wicket:id="huisartsOnbekend">De huisarts staat er niet tussen</button>
        <button data-dismiss="modal" class="btn" wicket:id="annuleren">Annuleren</button>
    </div>
</wicket:panel>
</html>
